{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T04:11:05Z","timestamp":1792123865337,"version":"4.4.0"},"reference-count":57,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Public Health Surveill"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Converging evidence indicates an adolescent mental health crisis in Western societies that has developed and exacerbated over the past decade. The proposed driving factors of this trend include more screen time, physical inactivity, and social isolation, but their causal influence on mental health is insufficiently understood.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The objective of this study is to test whether and based on which predictor variables the development of mental health in adolescents in the last decade can be predicted and to better understand the causal chain of factors at work.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We implemented an interpretable machine learning pipeline based on gradient boosting regression with repeated cross-validation to assess the development of mental health throughout adolescence in members of 2 longitudinal cohort studies, the British Millenium cohort (MC; n=8599) and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) cohort (n=1212). In total, 144 (MC) and 102 (KiGGS) predictors assessed at the age of around 13.8 years (MC) and 11.6 years (KiGGS) were used to assess mental health at the ages of around 16.7 years (MC) and 16.4 years (KiGGS). Based on these predictive models, we used permutation-based feature importance analyses to identify relevant predictors and predictor domains. Moreover, we performed partial dependence analyses in a causal inference framework to determine the direct effects of physical inactivity, screen time, and peer problems on the development of mental health.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The average cross-validated Pearson correlation coefficient (\n r<\/jats:italic>\n ) between predicted and true mental health in late adolescence was 0.614 (MC) and 0.466 (KiGGS). Feature importance analyses indicated a strong impact of preexisting mental health and weaker impacts of sex (female as a risk factor), physical health (chronic disease as a risk factor), lifestyle, and socioeconomic and family factors (eg, low parental education, income, and mental health as risk factors). Causal inference analyses suggested a strong direct effect of peer relationships, but only a small direct effect of physical inactivity and a very small direct effect of screen time.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Mental health development during adolescence can be assessed by a combination of variables from early adolescence. Peer problems represent an important direct cause of mental health development, and their deterioration may contribute to the current mental health crisis.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/60125","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T16:48:36Z","timestamp":1747068516000},"page":"e60125-e60125","source":"Crossref","is-referenced-by-count":5,"title":["Peer Relationships Are a Direct Cause of the Adolescent Mental Health Crisis: Interpretable Machine Learning Analysis of 2 Large Cohort Studies"],"prefix":"10.2196","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4011-8946","authenticated-orcid":false,"given":"Heiner","family":"Stuke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3340-0452","authenticated-orcid":false,"given":"Robert","family":"Schlack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4511-2211","authenticated-orcid":false,"given":"Michael","family":"Erhart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7498-6229","authenticated-orcid":false,"given":"Anne","family":"Kaman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2031-095X","authenticated-orcid":false,"given":"Ulrike","family":"Ravens-Sieberer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8274-1678","authenticated-orcid":false,"given":"Christopher","family":"Irrgang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"issue":"9826","key":"R1","doi-asserted-by":"publisher","first-page":"1630","DOI":"10.1016\/S0140-6736(12)60072-5","article-title":"Adolescence: a foundation for future health","volume":"379","author":"Sawyer","journal-title":"Lancet"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k2608","article-title":"Adolescent mental health in crisis","volume":"361","author":"Gunnell","journal-title":"Br Med J"},{"issue":"8","key":"R3","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1038\/s44220-023-00112-1","article-title":"Youth mental health crisis management","volume":"1","journal-title":"Nat Mental Health"},{"issue":"7","key":"R4","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/S2215-0366(23)00175-X","article-title":"Cross-cohort change in parent-reported emotional problem trajectories across childhood and adolescence in the UK","volume":"10","author":"Armitage","journal-title":"Lancet Psychiatry"},{"issue":"2","key":"R5","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1002\/wps.21087","article-title":"Prevalence and trends of common mental disorders from 2007-2009 to 2019-2022: results from the Netherlands Mental Health Survey and Incidence Studies (NEMESIS), including comparison of prevalence rates before vs. during the COVID-19 pandemic","volume":"22","author":"Ten Have","journal-title":"World Psychiatry"},{"issue":"8","key":"R6","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1007\/s00127-019-01697-8","article-title":"Recent increases in depressive symptoms among US adolescents: trends from 1991 to 2018","volume":"54","author":"Keyes","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"5","key":"R7","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.3886","article-title":"Trends in suicide among youth aged 10 to 19 years in the United States, 1975 to 2016","volume":"2","author":"Ruch","journal-title":"JAMA Netw Open"},{"issue":"4","key":"R8","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1024\/1422-4917\/a000936","article-title":"Prevalence and time trends of self-reported mental health problems among children and adolescents between 11 and 17 years in the KiGGS study","volume":"51","author":"Baumgarten","journal-title":"Z Kinder Jugendpsychiatr Psychother"},{"issue":"2","key":"R9","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1111\/bjc.12333","article-title":"Global prevalence of depression and elevated depressive symptoms among adolescents: a systematic review and meta-analysis","volume":"61","author":"Shorey","journal-title":"Br J Clin Psychol"},{"issue":"4","key":"R10","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1007\/s00127-022-02388-7","article-title":"Is the self-reporting of mental health problems sensitive to public stigma towards mental illness? 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